Provider Demographics
NPI:1558393140
Name:DAVIS, THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SUNDAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5253
Mailing Address - Country:US
Mailing Address - Phone:919-420-1682
Mailing Address - Fax:919-719-3531
Practice Address - Street 1:1520 SUNDAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5253
Practice Address - Country:US
Practice Address - Phone:919-420-1682
Practice Address - Fax:919-719-3531
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6849225100000X, 2251N0400X
FLPT26341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891168NMedicaid
1558393140Medicare PIN
NC2503471AMedicare Oscar/Certification